Care Home: Little Millfields

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What the care home does well The home provides a service that respects people`s individuality. Interactions between staff and people living in the home were friendly: Staff know them well and are able to provide support in a way that meets their needs and wishes. People living at Little Millfields benefit from opportunities for personal development and a fulfilling lifestyle. There was a good programme of activities provided, and access to community facilities was good. Little Millfields is good at maintaining family links between people living in the home and their relatives. The home provides a comfortable environment for people living there; the bedrooms reflect individual needs and tastes. The home is well managed and people living there benefit from being supported by well-trained and well-supervised staff. What has improved since the last inspection? This was the home`s first key unannounced inspection since it`s registration. Subsequently there is nothing that can be commented on in this section of the summary. What the care home could do better: There were no requirements made as a result of this inspection visit, although two recommendations were made to ensure that policies relating to complaints and adult protection need to be reviewed to ensure that they are current and in line with up to date thinking. Otherwise the home needs to continue to build on its good foundation of practice. CARE HOME ADULTS 18-65 Little Millfields 21 Mill Lane Weeley Heath Essex CO16 9BB Lead Inspector Neal Cranmer Unannounced Inspection 22nd May 2008 09:00 Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Millfields Address 21 Mill Lane Weeley Heath Essex CO16 9BB 01787 479491 01787 479406 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) TLC Care Homes Limited Miss Regina Green Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either whose primary needs on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accommodated is 5 2. Date of last inspection First inspection since registration. Brief Description of the Service: Little Millfields is a detached chalet style bungalow situated in a quiet residential area of Weeley, midway between the coastal town of Clacton-onSea and Colchester. The home is situated within five minutes walking distance of local shops. The property is on one level and has five bedrooms, one of which has a large en-suite, with the remaining bedrooms sharing the home’s remaining two bathrooms, a large lounge, two separate dining rooms and a utility room. The home is set in over ¼ of an acre of grounds and has large well maintained gardens. There is parking available to the front of the property for up to four to five vehicles. Fees for residing in the home are: £1.500.00 per week to £2.500.00 per week, there are no additional charges made. This information was made available by the home via their registered provider during a telephone call on the 18th June 2008. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people who use this service experience good quality outcomes. This report follows a key unannounced inspection of the home, which took place on the 22nd May 2008; this was the home’s first inspection since it’s registration. The home’s team leader and the registered provider were present throughout the inspection, and assisted in all aspects of the inspection. This inspection included observation of people living in the home (direct verbal interaction was not possible, due to their complex needs, and out of concern for not increasing their anxiety levels). In addition discussion took place with the team leader, the registered provider and members of the care team. A tour of the premises was undertaken during the course of the inspection, which included viewing of people’s rooms, bathing and toilet facilities, communal areas and gardens. A range of records were sampled during the course of the inspection visit, and were found to be in order. What the service does well: The home provides a service that respects people’s individuality. Interactions between staff and people living in the home were friendly: Staff know them well and are able to provide support in a way that meets their needs and wishes. People living at Little Millfields benefit from opportunities for personal development and a fulfilling lifestyle. There was a good programme of activities provided, and access to community facilities was good. Little Millfields is good at maintaining family links between people living in the home and their relatives. The home provides a comfortable environment for people living there; the bedrooms reflect individual needs and tastes. The home is well managed and people living there benefit from being supported by well-trained and well-supervised staff. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. People who may use the service and their representatives have the information needed to choose a home that will meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides people with a Statement of Purpose, which included all of the necessary information to enable them or their representatives to make an informed choice about the home’s ability to meet their needs. It included information regarding the management structure of the home, including the experience and qualifications of the senior management team, the number of staff employed along with their qualifications. The Statement of purpose also provided people with information specific to the environment including room sizes and dimensions. Also provided was information about how any complaints or concerns relating to the service should be raised. Two residents care plans were case tracked during the inspection, both of which evidenced that an admission assessment had been carried out, the assessments focussed on the following areas; Self-care and personal hygiene needs, domestic skills, physical healthcare needs, mental well-being, Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 9 communication skills, eating and drinking, dietary needs, and social interactions. All pre-admission assessments are undertaken by the home’s registered manager, and the Statement of purpose indicated that the assessment involves discussing the persons needs with all interested parties, spending time with the person referred observing them in their current environment and agreeing a care plan for admission. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. Individuals are involved to the best of their individual abilities in making decisions about their lives, and are supported to play an active role in planning the support they receive. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both of the care plans that were case tracked evidenced that they had been developed from the information taken from the admission assessments, and both provided specific guidelines for staff so that people’s daily routines were consistent and ensured that care was carried out in the way that they wished. This included specific guidelines about how people should be approached first thing in the morning for example ‘knock on the person’s door advise them of it being time to get up, if no response, retreat leave it fifteen minutes and then return. Failure to follow these specific guidelines could potentially upset the person’s routine for the remainder of the day’. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 11 The home’s Statement of Purpose stated that care plans are reviewed three monthly by the care team. In addition annual reviews are carried out, involving the Care Manager, relatives and other significant people involved in the person’s life. Both of the care plans seen had been recently reviewed. Observation of staff interacting with people living in the home were positive, and staff were seen to offer choices to people, this included choices about where they wished to sit, and whether they wished to play a ball game or go for a walk around the garden. Staff spoken with were able to demonstrate that routines in the home were flexible, evidence seen in care plans showed that people were able to choose when they wished to go to bed in the evening and get up in the morning. Discussion with staff indicated that mealtimes were not set at specific times, and that people could have them to fit in with their daytime activities. Both of the care plans seen contained evidence of risk assessment activity having been undertaken, risk assessments were in place on: including intentional self-harm, environmental risks, and risks in the community. The assessments identified the nature of the risk, the level of risk and the management strategies in place to minimise the risk. Discussion with staff evidenced that they knew the people living in the home very well, and were able to quickly recognise the triggers that might result in a person becoming upset or anxious. Evidence was seen during the inspection of staff dealing with some difficult situations, which they did in a professional, caring and well managed way, ensuring that at all times the person involved was treated with dignity and respect. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. People who use services are able to make choices about their lifestyle and supported to develop their life skills. Social, educational, cultural and recreational activities meet individual’s expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with staff as well as viewing of records showed that people living in the home partake in a range of social events both outside of the home as well as in-house. External events included going for meals out, attending a swimming pool, shopping, and going to the theatre. In-house activities included, spending time together with staff in 1.1 sessions, going for walks in the gardens, karaoke sessions, hand and feet massages, and watering the vegetables in the green house. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 13 During the inspection visit one of the people living in the home was seen having a walk around the garden with their key worker, something they often reportedly choose to do when they are feeling a little anxious. Discussion with staff indicated that people are supported to have some involvement in some of the home’s daily routines for example assisting with meals and washing up, although this is often of short duration, because many of the people living in the home have very short concentration spans, or may often become upset or anxious. The home is situated only five minutes walking distance away from the local shops, and people are supported by staff to walk to these occasionally. The home does have access to a vehicle for venturing out further a field. The home has an open door policy on the receiving of visitors, and they are always offered the opportunity to have a meal at the home when visiting their relatives. One of the care plans sampled during the inspection showed evidence of significant involvement of a family member, who was involved in every aspect of their relatives care. On the day of the site visit there were no relatives visiting the home. The home provides a varied and nutritious menu, with there being evidence of choices available. The home operates a four weekly rotational menu, which included specific menus for people with specific dietary needs. The kitchen in the home was modern, clean and domestic. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is good. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Records examined showed that care plans contained sufficient detail to ensure that people receive care in the way they wish, and wherever possible by staff of the same gender, this point was made evident when a female person was in need of assistance to meet a personal need, a male member of staff was seen to specifically search out a female colleague to support the lady. All of the people living in the home are registered with a General practitioner, and care plans examined contained evidence of input from a variety of healthcare professionals, including psychiatrists, psychologists, chiropodists, dentists, community nurses, and opticians. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 15 The management team and staff spoken with were able to demonstrate a good knowledge of people’s healthcare needs. The home provides a good standard of care to ensure that people’s healthcare needs are met. The home operates a Monitored Dosage System (MDS) for the administration of prescribed medication. At the time of the inspection there were no controlled medications in use in the home. A tour of the premises confirmed that medication is appropriately stored in a metal lockable cupboard. At the time of the inspection visit there was nobody living in the home who was able to manage their own medication. Medication administration records that were sampled were all in order, with no evidence of any gaps or omissions. All staff administer medication, but only upon completion of Essex County Council’s medication workbook, some of which were sampled as part of this inspection. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has in place a complaints policy, which was detailed and provided all of the necessary information to enable a concern or complaint to be raised. It was however noted that the policy was dated march 2004, and therefore requires updating, as some of the information included was outdated, such as reference to the National Care Standards Commission. There have been no complaints received in respect of the service since its registration. As with the complaints policy the home has a policy on adult protection, but this also requires updating to ensure it is in line with current practice. All of the staff employed in the home received training during their induction. This training was provided by the organisations own training officer. There is a procedure in place for the use of planned restraint, and all staff have received training in physical interventions, and are soon to receive some further training in this area. Discussion with staff indicated that they were aware of their responsibilities in respect of adult protection issues. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 17 There have been no adult protection referrals made in respect of the service since it was first registered. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. Quality in this outcome area is good. The physical design and layout of the home enables residents to live in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises confirmed that the home was kept in good decorative order. The home benefits from having it’s own full time maintenance person who keeps the home in a good state of repair. Internally the home was clean and tidy, and was bright and airy, and people living there were seen to have free access to all communal areas. The gardens are well kept and planted with mature shrubs; the gardens are very pleasant and easily accessible to people living in the home, who were seen making use of them on the day of the inspection. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 19 The home’s laundry facility was small and domesticated, situated just off the kitchen, although it had a separate entrance doorway to enable soiled or dirty laundry to be transported without interfering into the kitchen area. Both the washing machine and dryer were domestic in nature, but were deemed to be adequate to meet the needs of the people living in the home. On the day of the site visit the home was found to be clean and tidy and was free from any offensive or unpleasant odours. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, in line with their terms and conditions, and to support the smooth running of the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with the person in charge of the home at the time of the inspection indicated that the home employs eight to ten care staff, of which five hold a national Vocational Qualification (N.V.Q) at level two or above. At the time of the inspection visit the staffing levels in the home were three throughout the day, with nights being covered by one waking night staff and one sleep-in staff. These staffing levels were in place to meet the needs of four people living in the home. Staff were of the view that these levels were sufficient to meet peoples needs. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 21 The staff recruitment records for four of the home’s care staff were sampled, and provided evidence that a robust recruitment process was being carried out that adequately protected people living in the home. The recruitment process ensured that prior to employment of any member of staff the following information was obtained in respect of each of them: an application form, two written references (one of which was of the most recent employer), criminal records bureau check including protection of vulnerable adults (POVA 1st), evidence of induction, supervision and training. Discussion with the manager, as well as sampling of staff training records showed that staff had received training in the following areas; Protection of vulnerable adults, health and safety, fire safety, food hygiene, makaton and autism awareness. In addition to this training the following training had been scheduled for staff to attend; first aid training and inclusive communication training. Discussion with the manager and staff indicated that staff are provided with formal supervision every six to eight weekly, and is carried out by the registered manager and the team leaders. The manager stated that the home uses a standardised tool to carry out it’s supervisions. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. The management and administration of the home is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has significant previous experience of working in the care sector, and has specific experience in supporting people with the needs of those supported by the home. Discussion with the team leader and staff indicated that the registered manager provides them with a clear sense of leadership and direction, and was described by one of the staff as very much a ‘hands on manager’ would never expect anyone to do something that they would not be prepared to do Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 23 themselves. Further discussion indicated that the registered manager is open and approachable. The home intends to send out questionnaires annually to a range of stakeholders including; social workers, general practitioners, occupational therapists, families, service users, community nurse’s and advocates as part of it’s quality assurance process. In addition to this team meetings are held regularly, and regular audits are undertaken by the team leaders. Regulation 26 visits are carried out monthly by the registered provider or a representative of the organisation, and copies of these visits are provided to the home. There are a range of health and safety policies in place and staff spoken with are aware of their responsibilities around safe working practices. Policies in place included; health and safety, disposing of household waste, and food hygiene. Records examined confirmed that staff had received training around health and safety and fire safety. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? N/A STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA22 YA23 Good Practice Recommendations It is recommended that both the home’s complaints and adult protection polices be reviewed and where necessary updated to reflect current practice. Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Little Millfields DS0000071320.V364973.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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